The Lyme rash, or erythema migrans (EM) is a clinical manifestation of Lyme, occurring in people who become infected with Borrelia burgdorferi, the causative agent of Lyme disease. The EM is also known as the bull's eye rash, and has become closely associated with Lyme. The rash develops and slowly spreads from the site of the tick bite. It may be hot to the touch, raised, and itchy. It may come and go.


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Associated with early disseminated, or first stage Lyme disease, the rash will not develop in everyone with Lyme. However, everyone who develops the rash is certain to have Lyme. The list of symptoms for Lyme is varied and subjective. If the disease is not caught early, it can be incredibly difficult to obtain a correct diagnosis. Many Lyme symptoms, such as flu-like feelings, headaches, fatigue, and painful or swollen joints, can easily lead to a misdiagnosis. Many of these symptoms mimic other conditions, and a misdiagnosis can cause a crucial delay in treatment. Lack of proper treatment in the early stage can cause a patient to slip into a late disseminated stage, where there is considerable danger of continued misdiagnosis, and developing chronic problems. The EM, bull's eye rash, is one of the few sure signs of proof that a doctor needs to see in order to diagnose Lyme disease. If you have a bull's eye rash, be sure to take pictures so you can retain proof.


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According to the International Lyme and Associated Diseases Society (ILADS) physicians, the Lyme rash may occur in up to 50% of people infected with Borrelia burgdorferi. In other words, up to half of the people who have a Lyme infection may never develop a rash at all. Other doctors, such as Allen C. Steere, MD, writing in the New England Journal of Medicine, claim that in the United States, the EM rash occurs in 80% of Lyme patients.


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Of the significant percentage of people infected with Borrelia burgdorferi who never see a Lyme rash, it is possible that the rash has developed on the back of the knee, or somewhere else on the body where it went undetected. Some who have been infected never find a tick on their body, and may never detect a tick bite. In addition, some people develop skin rashes that do not conform to the bull's eye pattern.



Resources:

ILADS, the International Lyme and Associated Diseases Society

IDSA, the Infectious Diseases Society of America

The New England Journal of Medicine, "Lyme Disease," by Allen C. Steere, M.D.

Center for Disease Control and Prevention

Beating Lyme Disease, by Dr. David Jernigan, B.S., D.C., and Dr. Sara Koch Jernigan, B.S. D.C.

Coping with Lyme Disease: A Practical Guide to Dealing with Diagnosis and Treatment, by Denise Lang with Kenneth Leigner, M.D.


Copyright © 2008 Suzanne Arthur. All rights reserved.

Lyme Disease Rash